Getting Health Insurance Coverage Before Medicare Eligibility


Finding affordable health insurance is key to avoiding financial issues in your golden years. This can be especially difficult for those who retire or experience a change in employment status before turning 65, the age of general eligibility for Medicare.

Some people are fortunate to have access to retiree benefits through their former employer or their spouse. Historically, however, it has been challenging for people nearing retirement to buy coverage on their own, either because they are denied due to health conditions or the premiums are too expensive. Thanks to the Affordable Care Act (ACA), those nearing retirement have more health insurance options available to them than ever before.

Purchasing Individual Coverage on the Marketplace

The Health Insurance Marketplace sells individual and family health insurance plans. According to’s annual Health Insurance Price Index Report for the 2017 Open Enrollment Period, the average premium paid by policyholders ages 55-64 in 2017 was $695 a month. In addition, since 2014, consumers cannot be denied coverage due to pre-existing conditions.

Each year, the Health Insurance Marketplace features an Open Enrollment Period (not to be confused with Medicare’s Annual Open Enrollment Period). The window of opportunity to purchase health insurance coverage for 2018 begins November 1, 2017, and ends December 15, 2017.

Individuals may also take advantage of Special Enrollment Periods outside of Open Enrollment that are triggered by certain life events, such as losing your health care coverage, moving to a different county or zip code, or getting married. The window to purchase new coverage typically lasts up to 60 days following the qualifying event.

Short-Term Health Insurance Policies

There are private policies available that are designed to help people retain coverage during transitional periods in their lives. In cases where a senior is not eligible for Medicare, does not have any type of coverage available through their current or previous employer (or cannot afford it), has missed the Health Care Marketplace Open Enrollment, and does not qualify for a Special Enrollment Period, a short-term policy may be the best and only option available.

Since short-term policies are intended to be used as a temporary solution, they provide significantly reduced coverage when compared to long-term health insurance plans. Emergency services, hospitalization, and doctor’s visits for illness and injury are the core areas of coverage, whereas prescription drugs and preventative care are only partially covered at best.

Term health insurance policies do not meet the Affordable Care Act’s minimum essential coverage requirements, so purchasing one of these policies does not exempt policyholders from the ACA federal tax penalty.

Going without health insurance has serious consequences, including tax penalties. Knowing how to get covered this year is a smart way to protect your health and your nest egg.

The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided by PlanPrescriber.

Ross Blair is the founder and Chief Executive Officer of, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs.

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